Is a good sex drive a must for good health?

Your testosterone levels are a lot more important than you think

There is an unseemly side to being a health reporter, a side that entails more than press releases on the latest cancer findings and samples of the newest running shoes. There is the side that involves sex—sex masquerading as sexual health and, as such, sex that assumes the right to assault the bleary eyes of unsuspecting editors, innocently going through the morning mail, with such packaged goods as ridged condoms (size X-tra large), and, at least once, a vibrator in a velvet pouch. Such items are then quickly dispatched to the office giveaway table, in the hopes that, when they are discreetly hidden amid reject piles of novels, no one will suspect who put them there.

After all, while sex, in the context of disease, contraception, crime, or politics, hardly makes anyone blush these days, sexual pleasure—how often you want it, how good it is once you have it, given that everything is in working order—is still a private matter, best left discussed between close friends or, of course, in that other intimate forum, between talk-show host and studio audience. Viagra jokes notwithstanding, certain publicists and sex therapists may want you to believe that boring, uninspired sex is public-health-enemy number one, but the consensus has always been that hearty sex drives and terrific orgasms either happen or they don’t, depending on your personality, skill and whether you and your partner like each other much.

When sex does not interest you, then it might, just might, be a problem—a medical problem

When sex does not interest you, then it might, just might, be a problem—a medical problem

Recently, however, doctors are suggesting that this is worth examining. It is not healthy not to like or want sex. Rather than being considered a pastime, subject to personal preference, like wine-tasting or stamp collecting, sex, they say, is an important aspect of a healthy lifestyle. When sex does not interest you, then it might, just might, be a problem—a medical problem. And according to new findings from laboratories around the globe, it’s a problem that may be treated with a drug: namely, testosterone.

THE T THEORYTestosterone (as well as other hormones in its class, called androgens) is already administered in pills, creams and injections to treat bone and muscle ailments; it has also been combined with oestrogen in capsules to alleviate hot flashes; and superhuman doses of it have long been abused by athletes. But doctors in the US have increasingly been using it in very small amounts, under carefully monitored circumstances, as a cure for women with low libidos. There is also something called the testosterone patch, which is generating interest. While it’s not risk-free, it promises to be more practical.

There is also something called the testosterone patch, which is generating interest

There is also something called the testosterone patch, which is generating interest

Testosterone is being called the female Viagra. But, in fact, testosterone seems to be more than that: it broadens the parameters of how we define a medical condition. Men taking Viagra for erectile dysfunction have a physiological malfunction. Women with androgen deficiency syndrome (ADS), in contrast, are technically capable of doing their part during sex; they just don’t like doing it. So when doctors write a prescription for testosterone they are, in fact, acknowledging the need for a “lifestyle” drug.

“DARLING, I HAVE A HEADACHE”The condition is a very specific one if testosterone is to be a cure. It is more than just not wanting to have sex with a certain person, in a certain situation, or at a certain time—it’s not liking sex at all, even when the sex is “good” and it’s with someone you love.

As commonly assumed, a change in testosterone levels doesn’t only occur in postmenopausal women but can plague younger women, too. To understand why low levels of testosterone can wreak havoc on a woman’s sex life, one must do away with the notion of testosterone’s being a man’s hormone and oestrogen’s being a woman’s. Men and women produce both oestrogen and testosterone; it’s just that men produce a higher ratio of testosterone than women, and women a higher ratio of oestrogen than men. But the amount of testosterone we produce is hardly negligible. On average, premenopausal women produce 20 to 60 nanograms of the hormone per deciliter of blood in their ovaries and their adrenal glands—that’s four times the amount of oestrogen. Most of it is bound up to something called sex-hormone-binding globulin and the protein albumen; the rest (about 1 per cent) is a free agent. It is this 1 per cent that floats to the brain and turns our world upside down when we’re struck by a romantic crush or consumed by an object of desire.

NOT A MAGIC POTIONThis does not mean, however, that testosterone is the solution for anyone with a poor sex life. In fact, when given to women with already normal levels of testosterone, it could cause acne and facial-hair growth and, in pregnant women, birth defects. Some scientists even fear a cancer link. Unlike Oberon’s juice in A Midsummer Night’s Dream, testosterone will not create passion where it doesn’t already exist, nor will it make good sex great.

There are other reasons for testosterone dips, however, even in healthy women in their twenties and thirties

There are other reasons for testosterone dips, however, even in healthy women in their twenties and thirties

While there are no statistics as to how many women are affected by low testosterone levels, most women, especially healthy premenopausal women, have more probable causes to their problem. It could be painful sex because oestrogen is depleted. It could be making bad choices in men. It could be stress. It could be fatigue. It could be performance anxiety. It could be depression. And on and on.
What causes testosterone to diminish? Damage to the ovaries and adrenal glands (the manufacturing plants for testosterone)—and, alas, age. What people don’t realise is that there is no abrupt drop in testosterone across the menopausal transition. Instead, there’s a gradual decline with each passing year. By the time a woman reaches her mid-forties, she may have half as much testosterone as she did in her mid-twenties.

There are other reasons for testosterone dips, however, even in healthy women in their twenties and thirties. Certain birth control pills, ironically, may be a problem. Antidepressants, too, can pose problems. Having a reputation for being a downer for your love life, these otherwise mood-enhancing serotonin-reuptake inhibitors can also be adjusted.

Whether testosterone is the best treatment or not, the fact that there’s a medical solution at least gives women permission to look for help. In fact, as one case study points out in the book Restore Yourself: A Woman’s Guide To Reviving Her Sexual Desire And Passion For Life, it’s the difference between watching television in black and-white and watching it in colour.

Drugs like Viagra—though it ultimately proved less helpful for women than for men—were nonetheless a breakthrough for all of us, if only because they brought sexual medical issues into the public forum. And even though the patch, if approved (some say a few years from now), would be most widely used by postmenopausal women, doctors say it would also have an impact on those who are younger, simply by allowing them to recognise the importance of sexual pleasure—and to feel comfortable about seeking it out. But until then, that copy of the Kama Sutra on the giveaway table? I have no idea where it came from.

READY FOR TESTOSTERONE?Dr Kiran Cohelo, celebrity gynaecologist and head of department of gynaecology at Lilavati Hospital and Research Centre, Mumbai, tells us about testosterone therapies in the Indian context.

Are testosterone patches available in India?In India, patches don’t always work because of our climate. It’s always humid and they are likely to come off . Instead, I would suggest a lubricant, local hyperemic drug or gels for an increase in libido.

Who needs it the most?Perimenopausal women—that is women who are either going to enter menopause, those in it and those in a post-menopausal phase.